Okay so we’re all bored of Covid-19 right, but like-it-or-not it hasn’t gone away and whilst many think we are now in the second wave I would argue it’s still the first wave… it never disappeared, we just went into hiding and now we are “out” again nothing has really changed since the last big peak of cases. Or has it? Surely, we have learned something about this new disease this year… haven’t we?

Back in the blog in August called “My pandemic is worse than your pandemic” I mentioned I might do a future blog on the ancient disease called Cocoliztli, which I had never heard of before… well for once I’ve remembered I said I would do a particular topic and here it is!
 
So I’ve delve into my historical medical books (and Google!) to look further into the unknown pandemic of Cocoliztli.
 
It is well known that imported infections from Europe with the Spanish Conquistadors caused many deaths; Smallpox for example was imported in about 1520 and killed about 8 million people. In fact during the 16th Century about 90% of the native population of Mexico was wiped out by disease. But as if Smallpox wasn’t enough, this was followed in 1545 by the first Cocoliztli epidemic which killed a further 15 million people. Local people called this disease Cocoliztli or “pest” and as pandemics go this one seems pretty bad! A further Cocoliztli epidemic in 1576 killed another 50% of the population, so by this time more than 90% of the natives had been killed in just over 50 years!

“I have a patient with facial cellulitis but they’re not responding to antibiotics, my Consultant has asked me to find out if there is a stronger antibiotic we can give” said the oncall doctor.
 
The Microbiologist rolled his eyes; why do people persist in thinking about antibiotics in terms of “stronger” when what they really mean is “broader spectrum”!
 
“Why don’t you start by telling me something about the patient?” said the Microbiologist through gritted teeth.
 
“Oh, okay” said the Doctor, thinking this was just going to waste more of his precious time.
 
“She has just returned from trekking in Bolivia where they stayed in mud huts. The patient thinks they might have been bitten on the face as there were quite a lot of big beetles around. She now has a swollen right eye and we’ve been giving IV Teicoplanin but it hasn’t made any difference so we want to give her something… stronger.”
 
His curiosity piqued, the Microbiologist let the latest “stronger” slip past.
 
“Are both upper and lower eyelids swollen? What did the insects look like exactly?”

Back in November last year I wrote a blog about tick borne encephalitis (TBE) in the UK caused by viruses under the title “Deadly brain disease passed by ticks now in Britain”… not my title but rather the Telegraph newspaper. This was related to the discovery of deer ticks in Thetford Forest which showed evidence of infection with the TBE Flaviviruses. However this isn’t the only cause of TBE in the World, there are others such as the parasitic disease babesiosis… and you’ve guessed it…. we now have it here in the UK! Wonderful!?

“I have a patient with a bright red nose” said the junior Doctor.
 
The Microbiologist double-checked his calendar to make sure it wasn’t March 15th and the junior performing a joke for Comic Relief’s “Red Nose Day”, a charity day here in the UK!
 
“What do you mean a bright red nose” the Microbiologist asked, adding “it’s not Comic Relief Day, you know?” heading off the “fooled you” prank.
 
“What!?”... The junior inhaled deeply, ignored the Microbiologist, and continued “It’s a kind of reddish purple and very painful. It looks a bit like cellulitis but it is in a very odd place, and the patient doesn’t have a fever. What antibiotics do you think we should give?”
 
Muttering, “this isn’t just a dial an antibiotic line”, the Microbiologist decided he would like to see this patient’s nose and find out what was going on himself before advising what treatment should be started…
 
He added “your patient needs a diagnosis before throwing random drugs at them to see if they get better”.
 
As the Microbiologist walked into the patient’s room to introduce himself he couldn’t help but see that the patient did indeed have a bright red nose. He chuckled to himself; the patient definitely didn’t need one of those plastic red noses.
 
After a brief embarrassed pause the Microbiologist finally introduced himself. The patient smiled and then unconsciously reached up and stroked his nose with his thumb and forefinger.
 
With sudden understanding the Microbiologist asked “do you have anything to do with animals, either work or at home?”
 
“I am a keen keeper of Koi carp and have just finished transferring them to their new pond… I designed it myself” the patient said proudly.
 
It was the Microbiologists turn to smile. “You have erysipeloid” he told the patient confidently.
 
“Eh, sip, what? No, I have Koi carp, they’re fish!” said the patient, confused.

I came across a story this week about a patient from Florida, USA, who had been diagnosed with a really unusual infection caused by a microorganism called Naegleria fowleri. It caught my attention because firstly it is very rare and so I was intrigued and secondly because during a lockdown it should be extremely difficult to catch it! So I had to investigate further…
 
What is Naegleria fowleri?
Naegleria fowleri is a free-living amoeba found in freshwater and soil throughout the World, preferring temperatures between 30-45 oC. It does not survive in seawater. The most common risk factor for acquiring N. fowleri is contact with water through sports such as swimming, water skiing and diving as well as messing around in mud or bathing in contaminated hot springs (it is “free-living” after all!). So this explains my curiosity as to how this patient had acquired their infection as it should be very difficult to “get exposed” to N. fowleri during a lockdown, because there wouldn’t be any water sports or other exposures going on at this time!

“What antibiotics should we start for Nipah Virus?” asked the newly qualified Doctor.
 
The Microbiologist nearly fell off his chair.
 
“What?! Nipah Virus? Who the heck do you think has Nipah Virus?” exclaimed the Microbiologist.
 
“I have a patient with a headache and confusion and I’ve been reading about the causes of encephalitis and want to treat them in case it is Nipah Virus” the Doctor replied.
 
The Microbiologist muttered to himself… the only one confused here was surely this Doctor… why did this always happen on a Friday… I’m the only one with a headache…
 
“Has the patient travelled? Have they had any contact with animals? Have they been in contact with anyone else unwell?” asked the Microbiologist.
 
“Well no, but Nipah Virus can cause encephalitis so we should rule it out at least” said the Doctor defensively.
 
The Microbiologist sighed, “let me tell you a bit about Nipah virus….”

SARS Coronavirus 2 (SARS Cov2), the cause of the infection Covid-19, is a zoonotic infection; it has been transmitted from an animal to a human. Genetic analysis of the virus has shown that SARS Cov2 is an intestinal bat coronavirus that has successfully made the jump from bats to humans, probably as a result of human contact with bat guano.
 
Although that sounds alarming, zoonotic infections are actually quite common and have been a problem for Homo sapiens/humans ever since we crawled out of the primordial slime millions of years ago.

One of my biggest concerns around the current Covid-19 pandemic is that all of the normal things that make people sick haven’t gone away. This concerns me because whilst Covid-19 is on the minds of healthcare staff they may inadvertently delay considering all of the other clinical problems that will continue to be going on in the background. Patients will still be coming in with appendicitis, UTIs, heart attacks and strokes; in fact ANY acute medical or surgical problem that happens in a normal day in the NHS.

“We have a patient with an odd infection of the face and neck and want to know what antibiotics to start” said the ENT Doctor.
 
“What do you mean by odd?” asked the Microbiologist vaguely, distracted by all of the requests for coronavirus testing that where sitting in the laboratory.
 
“Well the patient has bilateral swelling of her face and neck and difficulty swallowing, and it’s a bit odd to be bilateral”.
 
The Microbiologist perked up and started to pay more attention.
 
“What does she do? Has she injured herself recently? Does she have pain on opening her mouth? What’s her vaccination history?” he asked.
 
“Errrr. She’s retired. We haven’t asked about injuries. She can’t open her mouth. She’s 77 years old so we haven’t asked about vaccines” answered the ENT Doctor.
 
“Okay. Go and ask her the questions. More specifically is she a keen gardener? Has she had any injuries, however minor, which might have been contaminated with soil or manure? When did she last have a tetanus immunisation? I’ll stay on the phone while you ask. This sounds like it might be tetanus”.
 
There was a pause, then the sound of the phone being put down on the desk, whilst the ENT Doctor went off to get some answers…
 
The Microbiologist tapped his desk nervously, “see, see not all patients are presenting with Covid-19, and I do wonder how many “ordinary” illnesses are being overlooked amongst the Covid-19 shenanigans…”
 
The ENT Doctor returned to the phone and asked … “are you still talking to me?”
 
“Oh umm, no I’m just ranting a little to myself” replied the Microbiologist.